PECPTA Membership Registration Form, 2018-2019
First Name *
Your answer
Last Name *
Your answer
Phone *
Your answer
Email *
Your answer
Address (Please include Street #/Name, City, State, & Zip) *
Your answer
Birth date *
MM
/
DD
/
YYYY
Spouse's Name
Your answer
Number of Children *
Child(ren)'s Name(s), Birthdate(s), & School(s) (If applicable) *
Your answer
Do you work outside the home? *
Required
What is your work schedule like? *
Are you a returning Member of PECPTA? *
If yes, what year did you join?
Your answer
Are you a first time Member of PECPTA? *
If you are a first time member, how did you hear about us?
Your answer
Do we have your authorization to use pictures of you, your child(ren) or family at PTA sponsored events for our website, Facebook page and/or promotional items? *
I understand that the Parma Early Childhood PTA, its officers and committee chair-persons shall not be held liable / responsible for accidents or injuries at any PTA function. Members are responsible for the safety and care of their own children at all activities. *
I understand that as a member of PECPTA, I am required to pay $15 annual dues, participate in a PECPTA committee, provide a refreshment for one meeting, provide a refreshment for one fundraiser, and raise $30 in fundraising for PECPTA. If I do not meet these requirements, I will not be permitted to participate in any private PECPTA events/outings or join again the following year. *
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